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Johannes Kepler, the astronomer who famously discovered that planets move in ellipses, presents an exceptional case we can reconstruct. Kepler got his assistant to paint an image of himself for a friend. This was just before Kepler stored up all his belongings to move his family back from Austria to Germany. His aged mother had been accused of witchcraft.

The post Thinking of Kepler on the beach appeared first on OUPblog.

By Aidan O’Donnell

How hard is it to execute someone humanely? Much harder than you might think. In the United States, lethal injection is the commonest method. It is considered humane because it is painless, and the obvious violence and brutality inherent in alternative methods (electrocution, hanging, firing squad) is absent. But when convicted murderer Clayton Lockett was put to death by lethal injection in the evening of 29 April 2014 by the Oklahoma Department of Corrections, just about everything went wrong.

Executing someone humanely requires considerable skill and training. First, there needs to be skill in securing venous access. Some condemned prisoners have a history of intravenous drug use, which obliterates the superficial, easy-to-reach veins, necessitating the use of a deeper one such as the femoral or jugular. Lockett was examined by a phlebotomist—almost certainly not a doctor—who searched for a vein in his arms and legs, but without success. The phlebotomist considered Lockett’s neck, before resorting to the femoral vein in his groin.

Second, there needs to be skill in administration of lethal drugs. The traditional triad of drugs chosen for lethal injection incorporates several “safeguards”. The first drug, thiopental, is a general anaesthetic, intended to produce profound unconsciousness, rendering the victim unaware of any suffering. The second drug, pancuronium, paralyses the victim’s muscles, so that he would die of asphyxia in the absence of any further intervention. However, the third drug, potassium chloride, effectively stops the heart before this happens. All three drugs are given in substantial overdose, so that there is no likelihood of survival, and the dose of any single one would likely be lethal. When used as intended, the victim enters deep general anaesthesia before his life is extinguished, and the whole process takes about five minutes.

Thiopental and pancuronium are older drugs, no longer available in the United States. US manufacturers have refused to produce them for use in lethal injection, and European manufacturers have refused to supply them. This has forced authorities to use other drugs with similar properties in untested doses and combinations.

Lockett was given 100mg of the sedative midazolam, intended to render him unconscious. Witnesses were warned that this execution might take longer than expected because midazolam acts more slowly than thiopental. Lockett appeared to be still conscious seven minutes later; nonetheless, three minutes after this, he was declared unconscious by a prison doctor. Vecuronium (a similar drug to pancuronium) was then administered to paralyse him, followed by potassium to stop his heart.

Journalist Katie Fretland, who was present at the execution, wrote that Lockett “lurched forward against his restraints, writhing and attempting to speak. He strained and struggled violently, his body twisting, and his head reaching up from the gurney” and uttered the word “Man”.

How can you tell if someone is unconscious? Though it is not clear what criteria the prison used to determine Lockett’s level of consciousness, the tool most widely used is the Glasgow Coma Scale (GCS). Developed in 1974 by Teasdale and Jennett, the GCS recognises something fundamental: consciousness is not a binary state, on or off. Instead, it is more like a dimmer switch, on a continuum from fully alert to profoundly unresponsive.

The GCS uses three simple observations: the subject’s best movement response, his best eye-opening response, and his best vocal response. A fully-conscious subject scores 15. Someone under general anaesthesia scores the minimum score of 3– one cannot score zero—and this is the score which I would expect Lockett to have after 100mg of midazolam. From the reports, we can infer that Lockett’s score was much higher; it was at least 8. It should never have been above 3.

The prison doctor determined that the intravenous line was not correctly located in Lockett’s vein, and that the injected drugs were not being delivered into his bloodstream, but instead into the tissues of his groin, where they would be absorbed into his system much more slowly.

Despite a decision to halt the execution attempt, Lockett was pronounced dead 43 minutes after the first administration of midazolam. It was widely reported that he died of a “heart attack”, but this is a very imprecise term. I surmise Lockett suffered a cardiac arrest, brought on by the gradual action of the lethal drugs. During those 43 minutes, Lockett was likely to be partly conscious, slowly suffocating as his muscles became too weak to breathe, and his heart was slowly poisoned by the potassium. How much of this he was aware of is impossible to estimate.

As an anaesthetic specialist, I am trained and skilful at establishing venous access in the most difficult patients. I am intimately familiar with all of the drugs which might reasonably be used, and I spend my professional life judging the level of consciousness of other people. I would seem to be an ideal person to perform judicial execution.

However, I never will. First, I consider judicial execution morally unacceptable. Second, it is profoundly unpalatable to me that the drugs I use for the relief of pain and suffering can be misused for execution. Third, I live in a country where execution is illegal. However, even if I lived in the United States, the American Medical Association explicitly and in detail forbids doctors to be involved (however tangentially) in judicial execution, leading me to question the involvement of doctors in Lockett’s execution.

Different authorities in the United States are executing prisoners using a variety of drugs in combinations and doses which are untested, and not subject to official approval. Of course, as soon as official approval for a particular regime is granted, suppliers will move to restrict the supply of those drugs for execution, and this cycle will begin again. Drain cleaner would work fine; will they go that far?

Lockett’s bungled execution should prompt us to consider some fundamental questions about lethal injection: Who should be involved? What training should they have? What drugs should they use? Where should they come from? And the most important question of all: isn’t it time the United States stopped this expensive and unreliable practice?

Aidan O’Donnell is a consultant anaesthetist and medical writer with a special interest in anaesthesia for childbirth. He graduated from Edinburgh in 1996 and trained in Scotland and New Zealand. He now lives and works in New Zealand. He was admitted as a Fellow of the Royal College of Anaesthetists in 2002 and a Fellow of the Australian and New Zealand College of Anaesthetists in 2011. Anaesthesia: A Very Short Introduction is his first book.

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Image credit: Lethal injection room, by the Californian State of Corrections and Rehabilitation. CC-PD-MARK by Wikimedia Commons.

The post Killing me softly: rethinking lethal injection appeared first on OUPblog.

        

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Goodreads Book Giveaway

Vagabonds

by Darcy Pattison

Giveaway ends May 09, 2014.

See the giveaway details at Goodreads.

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After the first draft, there’s are really two stories: there’s the one in your head (and it’s perfect) and the one you actually put on paper (and it’s not perfect). And they don’t match up. It’s OK. Don’t let this creativity gap give you writer’s block. Revision is the process of re-envisioning.!

THE GAP by Ira Glass from frohlocke on Vimeo.

If you can’t see this video, click here.

By Elizabeth Beck Neither Sarah nor I have met Troy Anthony Davis. I first met his family in about 2003, which was about 18 years into his death sentence when Sarah and I were working on In the Shadow of Death: Restorative Justice and Death Row Families. At the time, his sister

I’ve just read John’s ‘Pollyanna’ blog and boy, do I need to hold it in mind right now. Writing fiction? What’s that? Most of my writing time (I also run a youth theatre, am training to be a counsellor and spend far too much time doing school visits!) in the last week seems to have been taken up by sending e-mails, letters and Facebook messages because I have a penfriend, Eric Cathey, on Death Row whose execution date has been set for November 18th. I’ve recently been given the go ahead by his attorney as writing ‘can do no harm’ so am writing as much as I can in an attempt to save his life. The chances of my writing – or anybody else’s writing – making any difference are so slim (this is Texas I’m talking about and they’re executing two a week at present) that I almost feel like not bothering and working on the kids’ novel I’m trying to draw from the horror. (‘Wow! That’ll be a big seller then, Mum,’ says my sixteen year old daughter. ‘For 12-14 year olds? You think?’ She wanders off, shaking her head at her mother’s lunacy.) But my husband, the one who does the real work around here and funds my craziness, is sanguine. ‘You’re a writer. You have no choice. That’s what you’re here for.’ He doesn’t mean the fiction.
It was 85 days ago that I heard the news. There are 26 left out of a friendship that has lasted over 3 years. My latest letter arrived yesterday. Eric’s unit is on lockdown (all privileges, including hot meals, withdrawn because someone misbehaved – this isn’t the place for more detail) but Eric rejoices that he has been allowed a visitor, is glad that he is in good health at present and writes:
‘Yesterday my friend 6:6 fixed us something to eat and I swear, I never thought chilli and corn chips ever tasted so good! : ) So I got a chance to eat a good meal while listening to my favourite team win their first game of the season!’
Eric has been in solitary confinement for 23 hours a day for eleven years now, with no TV, just a radio. I think he could empathise with Pollyanna at the worst moments! What a continual and very present reminder he is to me to value my smallest blessings, including, as John points out, the support of my community. (The phone goes – it is a friend, bless him, checking that I am OK. Timing, hey?) Eric values the friends he makes shouting through the doors and the bars of the exercise areas, the few visitors who can visit once a week and talk to him through the plexi-glass and the letters from his eight penfriends. Even on Death Row the survivor makes community. Those that cannot, for whatever reason, lose their minds.
So yes, John, let us be deeply Pollyanna-ish in our gladness for whatever we have and most of all for the support of our communities – and, as we are writers, let us be particularly grateful for the communities we make through our writing.
If anyone does want to write or e-mail in defence of Eric, I would be very grateful. Personally, I don’t care if he’s guilty or innocent of the murder of which he was convicted; I am against capital punishment. But Eric has always claimed he is innocent and there is doubt about the ‘safety’ of his conviction, which has been the subject of several petitions. The details you will need are as follows:

Governor Rick Perry,
Office of the GovernorP.O. Box 12428Austin, Texas 78711-2428

e-mail: [email protected]

Eric's convict number is #999228. He 37 years old and is an inmate of the Polunsky Unit, Livingston, Texas.